Illinois Project for the Local Assessment of Needs (IPLAN

Illinois Project for the

Local Assessment of Needs

(IPLAN)

2017 – 2022

001

Clay County Health Department IPLAN 2017 - 2022

Table of Contents

Board of Health Review / Approval ……………………………………………………………………………..………………. pg. 3 Introduction ………………………………………………………………………………………………………………………………… pg. 4 Statement of Purpose …………………………………………………………………………………………………………………. pg. 4 Phase 1: Organize for Success……………………………………………………………………………………………………. pg. 5 Phase 2: Visioning ……………………………………………………………………………………………………………………… pg. 6 Phase 3: Assessments Local Public Health System Assessment ………………………………………………………………………….. pg. 9 Community Themes and Strengths Assessment ……………………………………………………………… pg. 10 Forces of Change Assessment ………………………………………………………………………………………... pg. 12 Community Health Status Assessment ……………………………………………………………………………. pg. 13 Phase 4: Identify Strategic Issues………………………………………………………………………………………………… pg. 14 Phase 5: Formulate Goals and Strategies…….……………………………………………………………………………… pg. 14 Phase 6: Action Cycle ………………………………………………………………………………………………………………… pg. 15 Appendix A – Community Health Assessment ……………………………………………………………………………. pg. 16 Appendix B – Community Health Improvement Plan…………………………………………….……………………. pg. 63

002

003

004

005

Phase 1: Organize for Success Purpose The first phase of MAPP involves two key components: 1) organizing the planning process and 2) developing the planning partnership. The purpose of this phase is to structure a planning process that builds commitment, engages participants as active partners, uses participants’ time well, and results in a plan that can be realistically implemented. The Process Planning Process In October 2016, the Health for Generations (H4G) Coalition met to begin the MAPP planning process. This core planning team was responsible for identifying the purpose, goals and potential barriers for the MAPP process. Additionally, the team brainstormed organizations and coalitions that exist in our community who could participate in the process. Partnership Development After the October 2016 meeting, Clay County Health Department sent invitations to participate in MAPP via email and mail to approximately 80 individuals. Our goal was to recruit broad community representation and select key stakeholders that would be active participants throughout the MAPP process. Potential committee members received an invitation with information about MAPP and four meeting dates between November 2016 and April 2017. In total, 43 of the invited organizations participated including representatives from the medical and hospital community, mental health and social service organizations, the cooperative extension service, schools, voluntary organization, business community, and faith community. Supporting Documents: Appendix A, Community Health Assessment, IPLAN Committee Participation, p. 46

006

Phase 2: Visioning Purpose The purpose of visioning is to engage community members in a creative process that leads to a shared community vision and common values. From this creative process, participants collectively develop vision and mission statements that provide focus, purpose, and direction to the MAPP process. Process In November 2016, the IPLAN Committee (aka Health for Generations or H4G) convened to participate in the visioning process. Images from magazines were cut out and spread across a table. Each participant looked through the images and picked 2-3 images that answered the question “What does a healthy Clay County look like to you?” The participants were then instructed to write down three words that described the images they chose. The facilitator encourages individuals to share the images and words they chose. The facilitator emphasized that these values should guide the MAPP process and reflect what is important to the Committee. From this meeting, the committee created a mission statement that identifies what the Committee should strive to achieve throughout the MAPP process. The vision statement provides a compelling and inspirational image of what the community will look like in the future. A wordle image (below) was generated from the words that people wrote down during the visioning activity. A draft of the statement was emailed to all Health for Generation Coalition members after the meeting to solicit their comments.

Vision Statement The Clay County Health for Generations Coalitions envisions an environment that supports a healthy lifestyle and health prevention activities that start early. We envision a public health system that is diverse and collaborative that encourages broad participation and effectively reaches the whole population, including the most vulnerable members of our community.

007

Phase 3: Local Public Health System Assessment Purpose The purpose of the Local Public Health System Assessment (LPHSA) is to assess local public health system’s capacity to provide the 10 Essential Public Health Services (EPHS) to the community. The local public health system includes all public, private, and voluntary entities that contribute to the delivery of public health services. Process The local public health system assessment (LPHSA) was conducted over the course of a month by meeting with local stakeholders and asking them to rate performance for each of the essential services on a scale of “no activity” to “optimal activity.” The tool was developed by NACCHO and CDC as part of the National Public Health Performance Standards Program (NPHPSP). The NPHPSP is a valuable tool in identifying areas for system improvement, strengthening partnerships, and assuring that a strong system is in place for effective response to day-to-day public health issues as well as public health emergencies. Data Analysis Scores from the NPHPSP assessments were entered into the CDC’s National Public Health Performance Standards Program website, which produced the Local Public Health System Performance Assessment (LPHSPA) Report of Results. Results Highest Scores:

• ES #1: Monitor Health Status to Identify Community Health Problems • ES #4: Mobilize Community Partnerships to Identify and Solve Health Problems • ES #7: Link to Health Services • EPHS #3: Inform, Educate, and Empower People about Health Issues

Lowest Scores:

• ES# 9: Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services

• ES #6: Enforce Laws • ES #10: Research Innovations

Documentation: Local Public Health System Performance Assessment Report of Results http://www.healthdept.org/images/Community/Local_Public_Health_System_Assessment_-_Feb._2017.pdf

008

http://www.healthdept.org/images/Community/Local_Public_Health_System_Assessment_-_Feb._2017.pdf

http://www.healthdept.org/images/Community/Local_Public_Health_System_Assessment_-_Feb._2017.pdf

Phase 3: The Assessments Forces of Change Assessment

Purpose The Forces of Change Assessment (FOCA) is designed to answer the following questions: “what is occurring or might occur that affects the health of our community or the local public health system” and “What specific threats or opportunities are generated by these occurrences?” During this phase, participants engage in brainstorming sessions aimed at identifying forces such as trends, factors, or events that are or will be influencing the health and quality of life of the community. Process In February, 2017, the Health for Generations Committee conducted the Forces of Change Assessment. Committee members were provided a brief tutorial on the forces of change and collaboratively brainstormed local events, trends, and factors that could influence the health and quality of life of the community. This activity generated a discussion on how to mitigate potential threats that may inhibit community health and how to capitalize on potential opportunities as we develop our community health improvement plan. Supporting Documents: Appendix A, Community Health Assessment

• Forces of Change Brainstorming Chart, p. 43

009

Phase 3: The Assessments Community Themes and Strengths Assessment

Purpose The Community Themes and Strengths Assessment (CTSA) is designed answer the following questions: “What is important to our community?” “How is quality of life perceived in our community?” and “”What assets do we have that can be used to improve community health?” The Process The Community Themes and Strengths Assessment (CTSA) was completed using three different strategies to try to obtain broad community input. Strategy 1: Community Assessment for Public Health Emergency Response (CASPER) Survey Strategy 2: Windshield Survey Strategy 3: Focus Groups The Health for Generations Coalition was involved in the design of each strategy, and the results of each strategy were shared with the Coalition. Strategy 1: CASPER Survey Method In May 2016, the Clay County Health Department deployed MRC volunteers to conduct a Community Assessment for Public Health Emergency Response (CASPER). CASPER, a CDC tool, interviews citizens in sampled households door-to-door about their public health needs. While CASPERS were developed to assess community needs after natural disasters or emergencies, the Clay County Health Department used this method to rapidly gain primary source public health data for use in the CTSA. The survey tool was developed with input from the Health for Generations Coalition and consisted of six sections: basic household information, household emergency plans, home and neighborhood safety, nutrition and physical activity, access to healthcare services and Clay County’s overall health. No personally identifying information was collected. The basic method for the CASPER is to use Geographic Information Systems to randomly select 30 census blocks with probability proportional l to size. In each of these 30 “clusters”, seven houses are randomly selected to interview. Volunteer teams were trained on the household selection method to ensure that they were chosen randomly. Residents of the selected households who were at least 18 years of age or older were considered eligible to participate. Teams were instructed to get verbal consent from the resident before proceeding with the interview.

010

For more detailed explanation of the CASPER data collection and analysis methodology, reference the “CASPER Final Report and Results” at http://www.healthdept.org/images/Community/Report%20-%20Clay%20County%20Health%20Department%20Final%20Report.pdf. Over the weekend of May 20th and May 21st 2016, interview teams were able to conduct 149 interviews. 20 additional interviews were conducted the following week (May 23rd- May 25th), for a total of 169 interviews. Strategy 2: Focus Groups Four focus groups were conducted among Pre-K parents, High School Students, and Senior Citizens using the Yale University Program for Recovery and Community Health Report’s 2009 qualitative analysis methods. Strategy 3: Windshield Assessment A windshield assessment was used to get a sense of the community and its characteristics from the viewpoint of a new resident to Clay County. This method was adapted from the Community Tool Box, a public resource developed and maintained by the University of Kansas. Supporting Documents: Appendix A, Community Health Assessment

• CASPER Results, p. 6 • Focus Group Results, p. 6 • Windshield Assessment Results, p. 7

011

http://www.healthdept.org/images/Community/Report%20-%20Clay%20County%20Health%20Department%20Final%20Report.pdf

http://www.healthdept.org/images/Community/Report%20-%20Clay%20County%20Health%20Department%20Final%20Report.pdf

Phase 3: The Assessments Community Health Status Assessment

Purpose The Community Health Status Assessment (CHSA) answers the questions, “How healthy are our residents” and “What does the health status of our community look like?” The results of the CHSA provide the IPLAN Committee with an understanding of the community’s current health status and identify trends and emerging health issues affecting the community (e.g. high obesity rates or low immunization rates). Method The MAPP Community Health Status Assessment (CHSA) method was followed. This includes gathering core indicators for broad-based categories and comparing the data to trend information and to peers, state, and national data. Healthy People 2020 (HP2020) is a nationwide agenda created by the US Department of Health and Human Services that provides 10-year national objectives for improving the health of all Americans. HP2020 provides national benchmarks and goals that are applicable at the national, state, and local levels. Clay County health data was compared to HP2020 target measures whenever possible. The broad-based categories analyzed in the assessment include:

• Demographic and Socioeconomic Characteristics • General Health and Access to Care Indicators • Maternal and Child Health Indicators • Chronic Disease Indicators • Environmental, Occupation, and Injury Control Indicators • Sentinel Events

Data Sources Health indicator data is compiled from a variety of primary and secondary data sources to create the Clay County Community Health Profile Report. These data sources include but are not limited to the IPLAN Data System, Illinois Behavioral Risk Factor Surveillance System (BRFSS), Illinois Department of Public Health (IDPH), Illinois Department of Transportation, US Census Bureau, Centers for Disease Control and Prevention, American Cancer Society, National Institutes of Health, and many more. Supporting Documents: Appendix A, Community Health Assessment, p. 9-40

012

Phase 4: Identify Strategic Issues

Purpose

During this phase of the MAPP process, participants developed a list of the most important issues facing the community. Strategic issues are identified by reviewing the results of the four MAPP Assessments and determining which issues will be specifically addressed in the community health improvement plan (CHIP).

Process

In February 2017, the IPLAN Committee completed the four MAPP assessments. The next step was to use the results of the four MAPP assessments to identify the top 3 strategic issues. Once the top 3 strategic issues were identified, the Committee could being development of the CHIP.

Each Health for Generations Coalition (H4G) member was asked to select the top five strategic issues in our community. Responses were collected via SurveyMonkey, a web-based survey tool. In March 2017, the H4G members were emailed the link to the survey and given two weeks to submit responses.

The results were compiled and prioritized based on the nominal group technique. The results of the survey were shared with the Committee in March 2017.

Top 3 strategic issues:

• Tobacco and Substance Use • Heart Disease and Obesity • Access to Care and Cancer

Phase 5: Formulate Goals and Strategies

See Supporting Document:

Appendix B, Community Health Improvement Plan

013

Phase 6: The Action Cycle Purpose During this phase of the MAPP process, the community implements the community health improvement plan developed during the Formulate Goals and Strategies Phase. Process In May, 2017, the Clay County Board of Health formally adopts Clay County Community Health Improvement Plan 2017-2022.

014

Appendix A – Community Health Assessment

COMMUNITY HEALTH ASSESSMENT

Clay County, IL

Prepared by the Clay County Health Department in March 2017

2017-2022

015

2

Table of Contents Acknowledgements…………………………………………………………………………………………………………………………………………..3 Introduction……………………………………………………………………………………………………………………………………………………..4 Methods…………………………………………………………………………………………………………………………………………………………..5 Vision Statement………………………………………………………………………………………………………………………………………………8 Demographics…………………………………………………………………………………………………………………………………………………..9 Indicators Section……………………………………………………………………………………………………………………………………………16

• General Health/Access to Health Care o Leading Causes of Death………………………………………………………………………………………………………….16 o Access to Health Care Professionals…………………………………………………………………………………………17 o Health Care Utilization……………………………………………………………………………………………………………..18

• Maternal and Child Health o Teen Births………………………………………………………………………………………………………………………………20 o Infant Mortality and Birth Characteristics………………………………………………………………………………..21

• Chronic Diseases o Cancer……………………………………………………………………………………………………………………………………..22 o Respiratory Conditions…………………………………………………………………………………………………………….25 o Heart Disease ………………………………………………………………………………………………………………………….26 o Obesity…………………………………………………………………………………………………………………………………….27

• Health Behaviors o Physical Activity……………………………………………………………………………………………………………………….28 o Nutrition………………………………………………………………………………………………………………………………….30 o Smoking…………………………………………………………………………………………………………………………………..31 o Substance Use………………………………………………………………………………………………………………..……….33

• Infectious Disease o Sexually Transmitted Infections……………………………………………………………………………………………….34 o Other Communicable Diseases………………………………………………………………………………………………..35

• Environmental o Built Environment……………………………………………………………………………………………………………………36 o Climate and Air Quality……………………………………………………………………………………………………………38

• Injury…………………………………………………………………………………………………………………………………………………..39 • Sentinel Events……………………………………………………………………………………………………………………………………40

Local Public Health System Assessment………………………………………………………………………………………………………….41 Forces of Change Assessment………………………………………………………………………………………………………………………..43 Community Participation……………………………………………………………………………………………………………………………….46 Supporting documents available on the Clay County Health Department Website:

• Community Health Status Assessment • Community Strengths and Themes Assessment • Local Public Health Assessment

016

3

•

This project could not have been possible without the support and contribution of many people and organizations across Clay County. A sincere thank you goes to the Health for Generations Coalition members for their time, dedication, expertise and contributions. Additional thanks to the participants in focus groups, surveys, and the staff from many agencies that helped us include the voices of diverse sectors across Clay County.

Support for this project was provided by:

� Clay County Counseling Services

� Coalition Against Drug Abuse

� Clay County Health Department Staff

� Clay County Medical Reserve Corps

� Clay County Hospital

� City of Flora

� Christopher Rural Health Planning Corps

� University of Illinois Extension

� Sherwin Williams

� Flora School District

� American Red Cross

� Clay County Food Pantry

� Country Financial

� Golden Circle Nutrition Program

� Clay County Farm Bureau

� Heritage Woods

� CEFS Public Transit

� Southern Illinois Counseling Center

� Clay Home Health and Hospice

� Clay County Board

� Richland Memorial Hospital

Acknowledgments

017

4

Statement of Purpose: In October 2016, the Clay County Health Department began preparations to engage in a community health planning process known as the Illinois Project for the Local Assessment of Needs (IPLAN). IPLAN was developed by the Illinois Department of Public Health (IDPH) to meet the requirements set forth in 77 Illinois Administrative Code 600. This administrative code mandates that all certified local health departments in Illinois conduct an IPLAN process every five years for recertification. IPLAN requires local health departments to create an organizational strategic plan, conduct a community health needs assessment, and develop a community health plan. The administrative code allows local health departments to use an equivalent planning process for completing IPLAN. The Clay County Health Department utilized the Mobilizing for Action through Planning and Partnership (MAPP) framework to conduct IPLAN 2017-2022.

Mobilizing for Action through Planning and Partnerships (MAPP) Mobilizing for Action through Planning and Partnerships is a strategic approach to community health improvement. The MAPP tool is a community health improvement planning process developed by the National Association of County and City Health Officials (NACCHO) in collaboration with the Centers for Disease Control and Prevention (CDC) and is designed to emphasize a community-driven and community-owned approach. The Clay County Health Department elected to utilize MAPP for its IPLAN process because of MAPP’s emphasis on creating a truly community-driven health improvement plan. MAPP consists of 6 phases. Phase 1: Organize for Success Phase 2: Visioning Phase 3: The Four Assessments

• Local Health System Assessment • Community Themes and Strengths Assessment • Forces of Change Assessment • Community Health Status Assessment

Phase 4: Identify Strategic Issues Phase 5: Formulate Goals and Strategies Phase 6: Action Cycle

Introduction

018

5

Partnership Development: The Health for Generations Coalition brainstormed organizations and coalitions that exist in our community who could participate in the process. The Clay County Health Department sent invitations to participate to approximately 80 individuals. Our goal was to recruit broad community representation and select key stakeholders that would be active participants throughout the MAPP process. In total, 43 of the invited individuals participated, including representatives from the medical and hospital community, mental health, and social service organizations, the cooperative extension services, schools, volunteer organizations, the business community and faith community (See IPLAN Committee Participation in supporting documents section).

Visioning: The Health for Generations Coalition convened in November, 2017 to create a vision for the community. Participants looked through images from magazines and chose ones that they thought answered the questions “What does a healthy Clay County look like to you?”, “What is your vision for Clay County?” The participants shared their images and a mission and vision statement was created as a group.

Community Health Status Assessment: Data indicators were chosen to answer the questions, “How healthy are our residents?” and “What does the health status of our community look like?” Core indicators for broad-based categories were chosen from secondary data sources and compared to peers, state, and national data. Additionally, the core indicators were compared with national Health People 2020 targets whenever possible. Healthy People 2020 (HP2020) is a nationwide agenda created by the US Department of Health and Human Services that provides 10-year national objectives for improving the health of all Americans. HP2020 provides national benchmarks and goals that are applicable at the national, state, and local level. Clay County Health data was compared to HP2020 target measures whenever possible.

Secondary Data Sources: � I-PLAN Data System � Illinois Behavioral Risk Factor Surveillance System

(BRFSS) � Illinois Department of Public Health, Vital Statistics � Illinois Department of Transportation � U.S. Census Bureau, American Community Survey � Small Area Income and Poverty Estimates � State Cancer Profiles � U.S. Environmental Protection Agency � CDC, National Vital Statistics System � Illinois Department of Public Health, Birth

Characteristics � National Oceanic and Atmospheric Administration,

North America Land Data Assimilation System � CDC, Division of Nutrition, Physical Activity and

Obesity

� Center for Disease Control and Prevention (via CDC WONDER)

� U.S. Department of Health and Human Services, Health Resources and Service Administration, Area Health Resource File

� University of Wisconsin, County Health Rankings. 2016 � Illinois Department of Children and Family Services � Illinois Youth Survey, Clay County 2016 � Dartmouth Collect Institute for Health Policy, Atlas of

Health Care � Feeding America � National Diabetes Surveillance System; Diabetes Atlas � National Center for HIV/AIDs, Viral Hepatitis, STD, TB

Prevention � Fatality Analysis Reporting System � Uniform Crime Reporting Program

Methods

019

6

Community Themes and Strengths Assessment: A variety of methods were used to get primary data to answer the questions: “What is important to our community?” “How is quality of life perceived in our community?” and “What assets do we have that we can use to improve community health?”

� Surveys: In May 2016, the Clay County Health Department deployed MRC volunteers to conduct a Community Assessment for Public Health Emergency Response (CASPER). CASPER, a CDC tool, interviews citizens in sampled households door-to-door about their public health needs. The survey tool was developed with input from the Health for Generations Coalition and consisted of six sections: basic household information, household emergency plans, home and neighborhood safety, nutrition and physical activity, access to healthcare services and Clay County’s overall heath. No personally identifying information was collected. The basic method is to use Geographic Information Systems to randomly select 30 census blocks with probability proportional to population size. In each of the 30 census blocks, seven houses are randomly selected to interview. Residents of the selected households who were at least 18 years of age or older were considered eligible to participate. Results were generalized to the entire county. More detailed information about the data collection and analysis methodology can be found in the “CASPER Final Report” document on the Clay County Health Department’s Website.

� Focus Groups: In February 2017, the Clay County Health Department conducted focus groups with community members. Members of the focus groups represented broad interest in the community, including those members of medically underserved, low-income, and populations that are at higher health risk.

Focus Group Date of Meeting # of Participants

Clay City Pre-K Parents 2/7/2017 22

North Clay Pre-K Parents 2/9/2017 10

Flora and North Clay High School Students 2/16/2017 17

Senior Citizen Group 2/21/2017 10

To perform the analysis on the focus group data there were three main steps. The Yale University Program for Recovery and Community Health Report’s (2009) qualitative analysis methods were followed. First, notes were taken at each focus group and a recording made. Common themes were created based on the number of times each theme was mentioned and evidence from each focus group was used to support the chosen themes. A full report with results is available by request from the Clay County Health Department. The results of the focus groups are integrated throughout the report. Specific quotes are included in “voices of the community” speech bubbles.

020

7

� Windshield Survey: A new resident to Clay County provided outside perspective to the strengths and themes of the community by performing a systematic assessment through observations made from a moving vehicle. The methodology for the windshield survey was adapted from the Community Tool Box, a public resource developed and maintained by the University of Kansas. The general guidelines for conducting a windshield survey were used to develop and direct the survey for Clay County, Illinois. The survey was conducted between October 2016 and February 2017. Throughout this time period, over 200 road miles were observed at various times and days of the week. A full report with the results is available by request from the Clay County Health Department. Pictures and comments are integrated throughout this report.

Local Public Health System Assessment: This assessment is intended to answer the questions, “What are the components, activities, competencies, and capacities of our local public health system?” and “How are the Essential Services of Public Health being provided in our community?” To complete this assessment, several small group meetings with stakeholders were held during the month of February, 2017. Within each of the 10 Essential Services, model standards that describe the key aspects of an optimally performing public health system, were rated by on a scale of “no activity” to “optimal activity.” Notes from the discussion were recorded as well as scores. A full copy of the report is available on Clay County Health Department’s website.

Force of Change Assessment: This assessment is intended to answer the questions, “What is occurring or might occur that affects the health of our community?” and “What specific threats or opportunities are generated by these occurrences?” The Health for Generations Coalition was provided a brainstorming worksheet one week before the February 2017 meeting. During the meeting, the committee discussed various trends, factors, and events that could influence the health and quality of life in our community.

021

8

The Clay County Health for Generations Coalitions envisions an environment that supports a healthy lifestyle and health prevention activities that start early. We envision a public health system that is diverse and collaborative that encourages broad participation and effectively reaches the whole population, including the most vulnerable members of our community.

Vision Statement

Voices of the Community

“Everyone knows everyone”

“Everyone is friendly”

“We are supportive of each other”

“It’s home to me!“

“Low crime rates”

“I love the nature and Charley Brown Park”

“I can work near where my children go to school

Why do you like living in Clay

County?

022

9

Clay County is a rural community located in the Southeastern portion of Illinois. The county has a total population of 13,675 residents. This is a 1.8% decrease in population since 2010. Despite the decrease in total population, there was an increase in the population of 20-24 year olds, and 60-64 year olds between the 2010 Census and 2014 American Community Survey. The county has an aging population. Since 2010, the median age has risen from 41.6 years to 42.7 years in 2010.

Table 1.1: Population Characteristics

Population 2010 2012 2014 Clay % of

population 2014

IL % of population

2014

percent change since 2010

Total population 13,927 13,828 13,675 100.0 100.0 -1.8% Male 6,749 6,753 6,745 49.3 % 49.1 % -0.1% Female 7,178 7,075 6,930 50.7 % 50.9 % -3.5% Age Under 5 909 880 840 6.1 % 6.3 % -7.6% 5 to 9 847 925 832 6.1 % 6.6 % -1.8% 10 to 14 942 848 967 7.1 % 6.7 % 2.7% 15 to 19 910 903 838 6.1 % 6.9 % -7.9% 20 to 24 693 712 832 6.1 % 6.9 % 20.1% 25 to 34 1,498 1,478 1,446 10.6 % 13.8 % -3.5% 35 to 44 1,781 1,651 1,516 11.1 % 13.2 % -14.9% 45 to 54 2,091 2,038 1,939 14.2 % 14.2 % -7.3% 55 to 59 913 988 934 6.8 % 6.6 % 2.3% 60 to 64 851 919 1,047 7.7 % 5.6 % 23.0% 65 to 74 1,206 1,233 1,280 9.4 % 7.2 % 6.1% 75 to 84 925 924 881 6.4 % 4.1 % -4.8% 85 + 361 329 323 2.4 % 1.9 % -10.5% Median age (years) 41.6 42.5 42.7 (X) 37.0 (X) U.S. Census Bureau, 2010-2014 American Community Survey

Demographics

023

10

Table 1.2: Race/Ethnicity Distribution Race Distribution Race 2010 Percent 2014 Percent % Change Total Population 13,927 100.0% 13,675 100.0% -1.8% One Race 13,813 99.2% 13,531 98.9% -2.0% White 13,675 98.2% 13,365 97.7% -2.3% Black or African American 44 0.3% 55 0.4% 25.0% American Indian and Alaska Native 4 0.0% 58 0.4% 1350.0% Asian 7 0.1% 17 0.1% 142.9% Native Hawaiian/Pacific Islander 0 0.0% 0 0.0% 0.0% Other Race 19 0.1% 36 0.3% 89.5% Two or More Races 114 0.8% 144 1.1% 26.3% Hispanic or Latino* 129 0.9% 179 1.3% 38.8% Source: U.S. Census Bureau, 2010-2014 American Community Survey

Clay County has a predominantly white population, accounting for 97.7% of the county’s total population. The racial makeup of the remaining 2.3% are 0.4% Black or African American, 0.4% American Indian or Alaskan Native, 0.1% Asian, 1.1% two or more races, and 0.3% of other race. People of Hispanic or Latino origin of any race accounted for 1.3% of the population. Only 3.2% of Clay County speaks a language other than English, with the predominant minority language being Spanish (2.6%).

Table 1.3 Languages Spoken Languages Speak only English 96.80% Speak a language other than English 3.20% Spanish 2.60% Other Indo-European language 0.40% Asian and Pacific Island language 0.10% Source: U.S. Census Bureau,2010- 2014 American Community Survey

Since 2010, the percentage of Clay County residents age 25+ with a high school degree or higher remains consistent with State levels. In Clay County the percentage of residents (13.4%) with at least a bachelor’s degree is still much lower compared to the state at 31.9%.

Table: 1.4: Educational Attainment by Percent of Population Age 25+

Level of Education 2010 2014

Clay IL Clay IL Less that High School 13.8% 13.1% 12.6% 12.4% High School grad or higher 86.2% 86.0% 87.3% 87.5% Bachelors or higher 13.8% 30.7% 13.4% 31.9%

Source: U.S. Census Bureau,2010- 2014 American Community Survey

024

11

Figure 1.1 Median Household Income

Data Source: “Small Area Income and Poverty Estimates,” US Census Bureau. 2004-2014

Figure 1.3 Population in Poverty

Data Source: “Small Area Income and Poverty Estimates,” US Census Bureau. 2004-2014

In 2014 (latest available data), the median household income in Clay County was $45,709 compared to the State median household income of $57,458. The Flora area has the lowest median household income. The percentage of the population living in poverty in Clay County has decreased slightly below the state average. An estimated 13.6% of Clay County residents were living in poverty compared to 14.3% of the State. The County’s unemployment rate, as of 2014 (5.8%) has decreased since its peak in 2009 (12.4%), and is currently comparable to the State (5.5%) and National averages (5.6%). Clay County has more than the State and National averages of residents receiving public assistance income, SNAP, and Medicaid (Data source: U.S. Census Bureau, American Community Survey, 2010-2014). In 2016, 42% of children lived in single-parent households, compared to 32% in Illinois. (Source: U.S. Census Bureau, American Community Survey, 2010-2014).

$45,709

$57,458

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Inco

me

in D

olla

rs

Median Household Income, 2004-2014

Clay Illinois

7.5%8.5%9.5%

10.5%11.5%12.5%13.5%14.5%15.5%16.5%

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Perc

ent

Percent of Population in Poverty, 2004-2014

Clay Illinois

025

12

The Institute of Medicine defines vulnerable populations as a group of people with certain characteristics that cause them to be at greater risk of having poor health outcomes than the general populations. These characteristics include, but are not limited to age, culture, disability, education, ethnicity, health insurance, housing status, income, mental health and race.

Population with a disability: This indicator reports the percentage of the total civilian non-institutionalized population with a disability. This indicator is relevant because disabled individuals comprise a vulnerable population that requires targeted services and outreach by providers.

Table 1.5 Population with a disability

Report Area

Total Population (For Whom Disability Status Is Determined)

Total Population with a Disability

Percent Population with a Disability

Clay County, IL 13,484 2,318 17.19%

Illinois 12,690,056 1,347,468 10.62%

United States 309,082,272 37,874,568 12.25%

Data Source: US Census Bureau, American Community Survey. 2010-14. Source geography: Tract Figure 1. 3 Map of Population with a disability

Disabled Population, Percent by Tract, ACS 2010-14

Over 18.0%

15.1 - 18.0%

12.1 - 15.0%

Under 12.1%

No Data or Data Suppressed

Report Area

Percent Population with a Disability

Clay County, IL (17.19%)

Illinois (10.62%) United States

(12.25%)

Identifying Vulnerable Populations

Demographics

026

13

Population with Limited English Proficiency: This indicator reports the percentage of the population aged 5 and older who speak a language other than English at home and speak English less than "very well." This indicator is relevant because an inability to speak English well creates barriers to healthcare access, provider communications, and health literacy/education.

Clay County has a total of 133 residents who reported understanding English less than “very well”.

Figure 1.4 Map of Population with Limited English

Population with Limited English Proficiency, Percent by Tract, ACS 2010-14

Over 4.0%

2.1 - 4.0%

1.1 - 2.0%

Under 1.1%


Report Area

Data Source: US Census Bureau, American Community Survey. 2010-14. Source geography: Tract

Veteran Population: This indicator reports the percentage of the population age 18 and older that served (even for a short time), but is not currently serving, on active duty in the U.S. Army, Navy, Air Force, Marine Corps, or the Coast Guard, or that served in the U.S. Merchant Marine during World War II.

Table 1.6 Veteran Population

Report Area Total Population Age 18 Total Veterans Veterans, Percent of Total Population

Clay County, IL 10,482 911 8.69%

Illinois 9,796,516 699,522 7.14%

United States 239,305,216 20,700,712 8.65% Data Source: US Census Bureau, American Community Survey. 2010-14.

027

14

Children with Food Insecurity: This indicator reports the estimated percentage of the population under age 18 that experienced food insecurity at some point during the report year. Food insecurity is the household-level economic and social condition of limited or uncertain access to adequate food.

Table 1.7 Child Food Insecurity

Report Area Population Under Age 18 Food Insecure Children, Total Child Food Insecurity Rate

Clay County, IL 3,167 840 26.52%

Illinois 3,022,155 643,040 21.28%

United States 73,580,326 17,284,530 23.49% Data Source: Feeding America

Food Desert: A food desert is defined as a low-income census tract (where a substantial number or share of residents has low access to a supermarket or large grocery store. This indicator is relevant because it highlights populations and geographies facing food insecurity. Approximately 2,517 Clay County residents live in a “food desert”.

Figure 1.4 Map of Food Deserts

Food Desert Census Tracts, 1 Mi. / 10 Mi. by Tract, FARA 2010

Food Desert

Not a Food Desert

No Data

Report Area

Data Source: US Census Bureau, County Business Patterns. Additional data analysis by CARES, 2014. Source geography: County

028

15

Households with No Motor Vehicle: This indicator reports the number and percentage of households with no motor vehicle based on the latest 5-year American Community Survey estimates.

A total of 247 households in Clay County are estimated to have no motor vehicle (4.57% of population).

Figure 1.5 Map of Households with No Motor Vehicle Access

Households with No Vehicle, Percent by Tract, ACS 2010-14

Over 8.0%

6.1 - 8.0%

4.1 - 6.0%

Under 4.1%


Report Area

Data Source: Centers for Disease Control and Prevention, National Vital Statistics System. Accessed via CDC WONDER. 2010-14. Source geography: County

029

16

In 2014, the leading cause of death in Clay County was heart disease with cancer as the second leading cause. Similarly, heart disease and cancer were the top two leading causes of death in the state of Illinois. Kidney Disease including nephritis, nephrotic syndrome, and nephrosis has risen to the top three in Clay County. Nearly 50% of deaths in Clay County (47.5%) can be attributed to these three causes: heart disease, cancer, and kidney disease. Clay County is ranked 92 out of 102 counties in Illinois for length of life. Premature death is calculated by counting the years of potential life lost before age 75 per 100,000 population. Clay County is getting worse for this measure. The CASPER Surveys found that the top three health isses were: heart disease/hypertension (59.2% of households with at least one membe), Asthma/COPD/Emphysema (28.7% of households), and Diabetes (22.5% of households). Table 2.1 Top Ten Leading Causes of Death in Clay County, 2014

Clay Illinois

Rank Cause of Death Number of Deaths Percent of Deaths Number % All Causes 146 100.0% 105,296 100.0%

1 Diseases of the Heart 37 20.3% 25,020 24.3% 2 Cancer 26 14.3% 24,504 23.8% 3 Kidney Disease 24 13.2% 2,517 2.4%

4 Chronic lower respiratory diseases 8 4.4% 5,633 5.5%

5 Diabetes Mellitus 6 3.3% 2,712 2.6% 6 Stroke 6 3.3% 5,490 5.3% 7 Accidents 4 2.2% 4,642 4.5% 8 Septicemia 4 2.2% 1,804 1.8% 8 Alzheimer's disease 2 1.1% 3,267 3.2%

10 Influenza and Pneumonia 2 1.1% 2,483 2.4% Source: Illinois Department of Public Health, Vital Statistics, 2014

Figure 2.1 Premature Death Trend

Data source: University of Wisconsin, County Health Rankings; National Center for Health Statistics, National Vital Statistics System, Mortality Files.

General Health and Access to Health Care Leading Causes of Death

030

17

The entirety of Clay County is designated as a “Health Professional Shortage Area” (HPSA), defined as having a shortage of primary medical care, dental, or mental health professionals. The access to primary care physicians is especially low.

� In 2014, there were 14.79 primary care physicians per 100,000 population � In 2015, there were 67 dentists per 100,000 population � In 2014, there were 96.1 mental health providers per 100,000 population

Data source: US Department of Health Human Services, Health Resources and Services Administration, Area Health Resource File. 2015.

During focus groups, access to health care came up in many forms and in all age groups. It was the #1 most common theme of all focus groups.

Local community stakeholders also mentioned access to healthcare

professionals during group meetings.

In the CASPER survey, access to health care was one of the top 10 health issues important to Clay County residents. Households reported examples of issues such as: mental health service availability, specialized physicians, and cancer care out of the area.


“We had to drive 4 hours today, back and forth to St. Louis to see a specialist” – North Clay Parent

“I wish there were more eye doctors. I go to Mt. Vernon” –Elderly Citizen

“We need a walk-in clinic!” – Clay City Parent

Local Stakeholder Input:

There are several groups in the community with unmet needs who are difficult to connect with personal health services, including people with developmental disabilities and people with high insurance deductibles. We lost the only Medicaid dental provider this year.

General Health and Access to Health Care Access to Health Care Professionals and Services

031

18

The CASPER household survey shows that 6.4% of Clay County’s population utilizes the Hospital Emergency Room for their primary and ongoing medical care. 18% of the surveyed households reported experiencing a “barrier to seeking medical care”, broken down by reason in the Figure below.

Table.2.2 Primary Medical Care Provider in Clay County

Frequency (n=169) Projected households Projected % 95% CI Who does your household use for primary and ongoing medical care?

Doctor's Clinic 145 5325 86.0% 78.6 - 93.4 Hospital ER 11 399 6.4% 1.2 - 11.7

Military 5 165 2.7% 0.4 - 5.0 Other 4 139 2.3% 0 - 4.5

Urgent Care/ Walk-in 3 91 1.5% 0 - 3.2 Don't Know 1 71 1.2% 0- 3.5

Data Source: Clay County Health Department CASPER Survey. May 2016.

Data Source: Clay County Health Department CASPER Survey. May 2016

Unable to get an appointment

17%

Incovenient provider office

hours17%

Distance10%

Lack of transportation

3%

Cost/lack of or insufficient coverage

33%

Other20%

Figure 2.2. For households that indicate a barrier to seeking medical care, what prevents your household from seeking medical attention?

General Health and Access to Health Care Health Care Utilization

032

19

Figure 2.3 Diabetic Monitoring Trend

Source: County Health Rankings, Dartmouth Atlas of Health Care

This shows the percentage of diabetic Medicare patients ages 65-75 whose blood sugar control was monitored in the past year using an A1C test. Clay County has shown improvement in this indicator since 2006. Clay County is getting better for this measure. Figure 2.4 Mammography Trend


This shows the percentage of female Medicare enrollees age 67-69 that had at least one mammogram over a two-year period. Clay County’s percentage is decreasing below the State and National averages. Clay County is getting worse for this measure.

033

20

Clay County’s teen birth rate is higher than Illinois and the United States, and it has been rising since 2002. The distribution of mother’s age in Clay County is younger than average. The Healthy People 2020 target is to reduce pregnancies among adolescent females aged 15-17 to 40.2 per 1,000. Table 3.1 Teen Birth Rate (2012)

Report Area Female Population Age 15 - 19

Births to Mothers Age 15 - 19

Teen Birth Rate (Per 1,000 Population)

Clay County, IL 448 22 48.6

Illinois 448,356 15,692 35

United States 10,736,677 392,962 36.6

Data Source: US Department of Health Human Services, Health Indicators Warehouse. Centers for Disease Control and Prevention, National Vital Statistics System. Accessed via CDC WONDER. 2006-12. Source geography: County

Teen Birth Rate (Per 1,000 Population)

Clay County, IL (48.6) Illinois (35) United States (36.6)

Figure 3.1 Teen Birth Rate Trend

Table 3.2 Mother’s Age 2014

Resident County

Total Births

Mother's Age Group (Years) < 20 20 - 24 25 - 29 30 - 34 35 - 39 40 +

ILLINOIS 158,522 6% 20% 27% 30% 14% 3% Clay 163 9% 35% 32% 21% 3% 1% ata Source: Birth Demographics by Resident County 2014, IDPH

Maternal and Child Health Teen Birth Rate

034

21

There were 163 births in Clay County in 2014. The infant mortality rate and percentage of low birth weights are not higher than the Illinois or National rates. Clay County is below the HP2020 target for infant mortality.

Table 3.3 Birth by Characteristics

Resident County

Total Births

Low Birth Very Low Birth Preterm (<37 weeks)

Weight Weight (<2,500 grams) (<1,500 grams)

Births Percent Births Percent Births Percent ILLINOIS 158,522 12,966 8.2 2,448 1.5 16,003 10.1 Clay 163 11 6.7 0 0 17 10.4 Data Source: Birth Characteristics by Resident County 2014, IDPH

Table 3.4 Birth by Additional Characteristics

Resident County

Total Births

Cesarean Births Mother Unmarried Not H.S. Graduate Age 20+

Births Percent Births Percent Births Percent ILLINOIS 158,522 49,473 31.2 63,521 40.1 15,778 10.7 Clay 163 48 29.4 70 42.9 14 9.4 Data Source: Birth Characteristics by Resident County 2014, IDPH

Table 3.5 Infant Mortality Rate (2006-2010 Aggregate)

Report Area Total Births

Total Infant Deaths

Infant Mortality Rate (Per 1,000 Births)

Clay County, IL 865 4 4.7

Illinois 879,035 6,065 6.9

United States 20,913,535 136,369 6.5

HP 2020 Target <= 6.0

Data Source: US Department of Health & Human Services, Health Resources and Services Administration, Area Health Resource File. 2006-10. Source geography: County

Infant Mortality Rate (Per 1,000 Births)

Clay County, IL (4.7) Illinois (6.9) United States (6.5)

Table 3.6 Infant Deaths (2010-2014) Infant Deaths 2010 2011 2012 2013 2014 Clay County 1 2 3 1 0 Data Source: IDPH Vital Statistics

Maternal and Child Health Infant Mortality and Birth Characteristics

035

http://www.healthypeople.gov/2020/about/default.aspx


22

Cancer was the #1 most commonly reported important health issue to residents in Clay County from the CASPER survey. In fact, it was reported twice as many times as any other health issue.

During focus groups, several people mentioned that they were concerned about Clay County’s cancer rate. There is a wide-spread perception in the community that cancer rates in Clay County are especially high.

Clay County’s cancer mortality rate is slightly higher than the Illinois and National Rate, all of which are higher than the Healthy People 2020 Target (160.6). Additionally, Clay County’s cancer incident rate is slightly higher than the National rate for breast cancer, colon cancer, and prostate cancer. With a rate of 79.5 per 100,000 population, Clay County’s lung cancer incidence is much higher than the rest of the nation(62.62).

Table 4.1 Cancer Mortality Rate

Report Area

Total Population

Average Annual Deaths, 2010-2014

Crude Death Rate (Per 100,000 Pop.)

Age-Adjusted Death Rate (Per 100,000 Pop.)

Clay County, IL 13,679 33 244.18 174.5

Illinois 12,867,528 24,326 189.05 173.9

United States 313,836,267 581,919 185.42 166.3

HP 2020 Target <= 160.6


Cancer Mortality, Age-Adjusted Death Rate (Per 100,000 Pop.)



“There is a lot of cancer in the community and I don’t know why”

“Why does Clay County have such a high cancer rate?”

Chronic Diseases Cancer

036



23

Table 4.2 Breast Cancer Incidence Rate

Report Area

Estimated Total Population (Female)

New Cases (Annual Average)

Cancer Incidence Rate (Per 100,000 Pop.)

Clay County, IL 1,027 13 126.5

Illinois 741,089 9,523 128.5

United States 18,056,679 222,845 123.41

Annual Breast Cancer Incidence Rate (Per 100,000 Pop.)


Table 4.4 Colon and Rectum Cancer Incidence

Report Area Estimated Total Population




Illinois 1,382,781 6,264 45.3

United States 33,989,067 137,973 40.59

HP 2020 Target <= 38.7

Data Source: State Cancer Profiles. 2009-13. Source geography: County * the age adjusted incidence rate (cases per 100,000 population per year) of colon and rectum cancer adjusted to 2000 U.S. standard population age groups

Annual Colon and Rectum Cancer Incidence Rate (Per 100,000 Pop.)


Table 4.3 Prostate Cancer Incidence

Report Area

Estimated Total Population (Male)



Clay County, IL 873 11 126

Illinois 650,000 8,372 128.8

United States 16,301,685 201,179 123.41

Annual Prostate Cancer Incidence Rate (Per 100,000 Pop.)

Clay County, IL (126) Illinois (128.8) United States (123.41)

037



24

According the U.S. EPA, Radon is the second leading cause of lung cancer, and the number one leading cause of lung cancer in non-smokers. During the CASPER survey, households were asked if they have tested their home for Radon. Only 13.4% of households knew that their house had been tested for Radon.

Table 4.5 Lung Cancer Incidence





Illinois 1,370,544 9,306 67.9

United States 33,999,704 212,905 62.62

Data Source: State Cancer Profiles. 2009-13. Source geography: County* the age adjusted incidence rate (cases per 100,000 population per year) of colon and rectum cancer adjusted to 2000 U.S. standard population age groups

Annual Lung Cancer Incidence Rate (Per 100,000 Pop.)


Table 4.6. Home and Neighborhood Safety

Frequency (n=169) Projected households Projected % 95% CI

Has your household been tested for radon?

Yes 21 828 13.4% 5.9 - 20.9 No 115 4188 67.7% 57.0 - 78.3

Don't Know 33 1175 19.0% 10.0 - 28.0

Data source: Clay County Health Department CASPER Survey. May 2016

038

25

The rate of death due to lung disease (Chronic Lower Respiratory Disease) per 100,000 population is significantly higher in Clay County (60.4) than in Illinois (39.2) or nationally (41.7). For another respiratory condition, asthma, the prevalence is lower in Clay County than it is in Illinois or Nationally. Chronic Lower Respiratory Disease was the 4th leading cause of death in Clay County (IDPH Vital Statistics). During the CASPER survey, asthma/COPD/emphysema was the second most commonly reported health issue, with 28% of households reporting that at least one member of the household had one of these conditions. The CASPER survey also found that approximately 6.7% of households have at least one member using an oxygen supply. Concern about respiratory conditions was not brought up in focus groups, stakeholder meetings, or open ended survey questions often.

Table 4.7 Lung Disease Mortality Rate

Report Area Total Population




Clay County, IL 13,679 12 89.19 60.4

Illinois 12,867,528 5,419 42.12 39.2

United States 313,836,267 144,125 45.92 41.7

Data Source: Centers for Disease Control and Prevention, National Vital Statistics System. Accessed via CDC WONDER. 2010-14. Source geography: County * the rate of death due to chronic lower respiratory disease per 100,000 population. Figures are reported as crude rates, and as rates age-adjusted to year 2000 standard

Lung Disease Mortality, Age-Adjusted Death Rate (Per 100,000 Pop.)


Table 4.6 Asthma Prevalence

Report Area Survey Population (Adults Age 18 )

Total Adults with Asthma

Percent Adults with Asthma

Clay County, IL 26,959 2,427 9%

Illinois 9,701,927 1,265,744 13%

United States 237,197,465 31,697,608 13.4% Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. Additional data analysis by CARES. 2011-12. Source geography: County

Percent Adults with Asthma

Clay County, IL (9%) Illinois (13%) United States (13.4%)

Chronic Diseases Respiratory Illness

039

26

The percentage of adults with heart disease in Clay County (11.3%) is significantly higher than the state (3.8%) and national averages (4.4%). Diseases of the heart is the leading cause of death in Clay County (IDPH Vital Statistics). In Clay County, there are an estimated 50.3 deaths due to cerebrovascular disease (stroke) per 100,000 population. This is greater than the Healthy People 2020 target of less than or equal to 33.8. The CASPER household survey found that more than half of households (59.2%) had at least one member with hypertension or heart disease. Additionally, heart disease was the third most commonly identified health concern by the community during the CASPER survey.

Table 4.9 Heart Disease Prevalence


Total Adults with Heart Disease

Percent Adults with Heart Disease

Clay County, IL 26,959 3,048 11.3%

Illinois 9,681,141 369,926 3.8%

United States 236,406,904 10,407,185 4.4%

Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System. Additional data analysis by CARES. 2011-12. Source geography: County


Clay County, IL (11.3%) Illinois (3.8%) United States (4.4%)

Table 4.9 Stroke Mortality Rate





Clay County, IL 13,679 10 76.03 50.3

Illinois 12,867,528 5,368 41.72 37.9

United States 313,836,267 129,754 41.34 37.3

HP 2020 Target <= 33.8


Stroke Mortality, Age-Adjusted Death Rate (Per 100,000 Pop.)


Chronic Diseases Heart Disease

040



27

Clay County’s obesity rate has increased to 32% since 2004. The Illinois and National rate seem to be decreasing slightly, while Clay County’s obesity trend is increasing. The Healthy People 2020 adult obesity target is 30.5%. The adult diabetes rate in Clay County (8.8%) is not very different than what is observed in Illinois (8.4%) and the United States (9.2%) (Source: CDC National Center for Chronic Disease Prevention and Health Promotion). Obesity was the second most commonly reported important health issues from Clay County citizens through the CASPER survey. Diabetes was the third most commonly reported health condition during the CASPER survey, with 22.5% of homes reporting that at least one household member had diabetes.

Figure 4.1 Adult Obesity

Data Source: County Health Rankings; National Diabetes Surveillance System; Diabetes Interactive Atlas

Chronic Diseases Obesity and Diabetes

041

28

The percentage of adults in Clay County who report no leisure time physical activity has grown over the last ten years to 33%. The CASPER survey showed that residents of the average Clay County household exercised 3 days in a week. 35% of Clay County households had residents that exercised every day! But, in 25% of Clay County households, no one exercised in the last 7 days.

Figure 4.2 Physical Inactivity

Data Source: County Health Rankings; CDC National Diabetes Surveillance System, Behavioral Risk Factor Surveillance System


0%5%

10%15%20%25%30%35%40%

0 days 1 day 2 days 3 days 4 days 5 days 6 days 7 days

Figure 4.3. How many days during the last 7 did a member of your household perform at least 30 min of physical activity

(other than during your regular job)?

Health Behaviors Physical Activity

042

29

The CASPER survey asked households what prevented them from exercising. For households where members exercised less than 3 days per week, the main barriers reported were: don’t want to, don’t have time, and physical disability.

During focus groups, many residents wanted more infrastructure to be able to be physically active more. Local stakeholders also expressed interest in developing programs or improvements to encourage residents to be more physically active.



“We don’t have a great place to walk… if we had a walking path in town that

would be awesome”

“I wish I could go to yoga class, but I am working the only times it is offered”

“We need an indoor swimming pool!”

“I love Charley Brown Park!”


We need to figure out how to motivate people to choose physical activity. There are lots of opportunities for “everyday exercise” like walking around the field at your child’s sports practice instead of sitting on the bleachers. The gyms and wellness programs at work places are not utilized nearly as much as they could be.

Expensive5% Don't have

time12%

Distance1%Physical disability

13%

Other health

concern8%

Don't want to

18%Other5%

N/A -nothing prevents

38%

Figure 4.4. For households where members exercised 3 days or less in the last 7 days, what prevents your household from

exercising?

Walking outside with no sidewalks

Charley Brown Park offers physical activity options

043

30

The CASPER household survey found that the average Clay County household ate at a restaurant or other food vendor 2 times per week. The survey asked households what prevented them from eating nutritious foods. For households that ate out 4 or more times per week, the majority reported that “nothing prevented” them from eating nutritious foods. For those that did report a barrier, the most common were: don’t want to, and time for preparing.


0%5%

10%15%20%25%30%35%


Figure 4.5. How many days during the last 7 days did you or a member of your household eat a meal from a restaurant or

food vendor?

Expensive3%

Local selection quality

3%

Don't want to15% Time for

preparing6%

Other3%

N/A - nothing prevents

70%

Figure 4.6 For households that ate our 4 or more days, what prevents your household from eating nutritios foods?

Health Behaviors Nutrition

044

31

The prevalence of tobacco smokers is much higher in Clay County (40.2%) than in Illinois (18.4%) and nationally (18.1%) (CDC, BRFSS). This is a leading cause of Clay County’s poor health outcomes in lung cancer and heart disease. More than half of Clay County residents have been smokers at some time in their life (63.4%) making them at risk for lung cancer and heart disease. Data from the Center for Disease Control and Prevention estimates that more than 7,000 Clay County adult smokers tried to quit smoking in 2011-2012. The CASPER survey found that 16.8% of households had at least one household member who tried to quit smoking in the past 12 months. The Healthy People 2020 target is to reduce the percentage of adults currently smoking to 12.0%.

Table 4.12 Former Tobacco Smokers Prevalence- Adults

Report Area

Survey Population (Adults Age 18 )

Total Adults Ever Smoking 100 or More Cigarettes

Percent Adults Ever Smoking 100 or More Cigarettes

Clay County, IL 26,959 17,092 63.40%

Illinois 9,659,812 4,258,470 44.08%

United States 235,151,778 103,842,020 44.16%




During focus groups, community members of all age groups brought up tobacco use as a health problem in Clay County. The open ended CASPER survey question also found that tobacco use is one of the top 10 perceived important health issues to Clay County citizens.

Health Behaviors Tobacco Use


“My son still smokes no matter how much they cost” – Elderly Citizen

“These young kids can get anybody to get them some cigarettes”- Elderly Citizen

“Lots of vaping. People don’t think they are using tobacco”- High School Student

“Junior high kids are getting into drinking and smoking”- High School Student

Cigarette butt litter

045

32

The 2016 Illinois Youth Survey of 8th, 10th, and 12th graders in Clay County found that 13% of 8th graders had tried cigarettes, 15% of 10th graders and 35% of 12th graders. The most common sources of cigarettes for all grades was from a friend of sibling. Other common sources included taking them from home without parents knowing and in 12th grade buying them from a gas station. Of 12th grade tobacco users, 25% reported that their parents gave them cigarettes. (Data Source: Illinois Youth Survey. Clay County 2016). The Clay County Health Department conducted a survey in 2016 in all junior high and high school classroom in Clay and Richland Counties. The survey found that approximately 20.6% of students in Clay and Richland Counties reported using cigarettes in the past 30 days, and 10.2% of those students reported being current frequent users (Data Source: Clay County Health Department Youth Tobacco Survey). The Healthy People 2020 target is to reduce the percentage of adolescents who use cigarettes to 16%.

Figure 4.7 Maternal Smoking (2000-2008)

Source: I-QUERY, IDPH Vital Statistics The latest available data (2008) shows that maternal smoking rate is higher in Clay County than in Illinois, but is on a decreasing trend. More current data is not available.

422.8

534.1

395.4

350.2

451.4

508.6

370.1412.0

329.5

126.7121.2 113.9 110.9 116.4

97.5 98.7 97.089.8

0.0

100.0

200.0

300.0

400.0

500.0

600.0

2000 2001 2002 2003 2004 2005 2006 2007 2008

Age-

Adju

sted

Rat

e pe

r 100

,00

Mothers Who Smoke During Pregnancy, 2000-2008

Clay

Illinois

046

33

Illegal drug use was the 4th most commonly reported “important health issue” on the CASPER survey. Alcohol use was the 9th most important. The 2016 Illinois Youth Survey finds that by 12th grade, more than half of students (55%) had tried some type of substance including alcohol and drug.

Table 4.12 Clay County Youth Substance Use

Illinois Youth Survey, Clay County 2016

Drug use was one of the main themes that was brought up repeatedly by different age groups during focus groups. The community seems to be especially concerned with youth drug use.

Health Behaviors Substance Use


“I have seen so many kids in high school doing drugs.”- Elderly Citizen

“The parents do it, so the kids think it is okay.” – Elderly Citizen

“Teens are selling drugs to other teens.”-High School Student

047

34

Chlamydia rates in Clay County are quickly climbing to meet the state and national rates. Gonorrhea rates have remained low, far below the state and national rates. HIV/AIDs rates are suppressed for Clay County because there are too few counts. In 2010, 93.8% of Clay County adults reported having never been tested for HIV/AIDs (Data Source: Illinois Behavioral Risk Factor Surveillance System). There was 1 case of early syphilis between 2010 and 2015. (Data Source: Illinois Department of Public Health STD Program)

Figure 5.1 STI Rate- Chlamydia Trend

Data Source: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Figure 5.2 STI Rate – Gonorrhea Trend

Data Source: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Infectious Diseases Sexually Transmitted Diseases

048

35

In Clay County and adjacent counties, tuberculosis (TB) incidence rates are very low due to the low number of reported tuberculosis cases. Clay County had no reports of TB between 2010 and 2015. The number of Hepatitis C. cases in Clay County has increased in the last 5 years.

Table 5.1 Tuberculosis Cases per County

County 2010 2013 2014 2015 Clay 0 0 0 0 Effingham 0 0 0 1 Marion 0 0 0 0 Richland 0 0 0 0 Source: IDPH, Tuberculosis Cases by Illinois County of Residence, 2006-2010

Figure 5.3 Hepatitis C Cases

Source: I-QUERY, Illinois Department of Public Health

In the Illinois Behavioral Risk Factor Surveillance System Survey conducted in 2010, 40.8% of participants in Clay County had a flu vaccine in the past year, and 30.1% had a pneumonia vaccine. The Healthy People 2020 goal is to have 70% of adults vaccinated annually against seasonal influenza.

12

0

2

4

6

8

10

12

14

2009 2010 2011 2012 2013 2014 2015

Hepatitis C. Cases in Clay County 2009-2015

Infectious Diseases Other Communicable Diseases

049

36

The Center for Disease Control and Prevention defines the built environment as “including all of the physical parts of where we live and work (e.g. homes, buildings, streets, open spaces, and infrastructure.” The built environment influences a person’s level of physical activity. For example, inaccessible or nonexistent sidewalks and bicycle or walking paths contribute to sedentary habits. These habits lead to poor health outcomes.

Many comments made during focus groups were about built environment and infrastructure issues. Additionally, in the CASPER survey, infrastructure was reported several times as a top health issue in Clay County. Comments from the open ended CASPER question included: roads not wide enough, lack of gyms, too many fast food restaurants. The CASPER survey found that approximately half of citizens (57%) think there is adequate road space for walking and biking safely in their neighborhood.

Table 6.1 Home and Neighborhood Safety

Frequency (n=169) Projected households Projected % 95% CI Does your household think there is adequate road space or sidewalks to walk or bike safely in your neighborhood?

Yes 102 3551 57.4% 46.4 - 68.4 No 62 2213 35.8% 25.8 - 45.7

Don’t Know 2 427 6.9% 0 - 16.7 Data source: Clay County Health Department CASPER Survey. May 2017

Environmental Built Environment


“We don’t even have a block, I can’t walk outside!”

“Some of the roads are in bad condition.”

“I don’t really like all of the fast food restaurants.”

“I wish we had a swimming pool and a dog park!”


Several local stakeholders have expressed interest in developing a community garden and increasing walking/biking path options. An effort like this would take partnerships and dedication

Walking outside with no sidewalks

050

37

The CDC Modified Retail Food Environment Index reports the percentage of the population living in a census tract without retail food stores where healthy food can be purchased. Approximately 37% of Clay County residents have low to no access to healthy foods.

Figure 6.1 Food Access

Data Source: Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity. 2011. Source geography: Tract

Inventory:

• Clay County has 8 fast food restaurants • Clay County has 2 grocery stores • Clay County has 3 liquor stores • Clay County has 2 fitness facilities

Data source: US Census Bureau, County Business Patterns. 2014

Approximately 19% of Clay County citizens live within ½ mile of a park, compared to 59% of people living in Illinois (Data source: CDC-Environmental Health Tracking).

Photos of Clay County parks

Photo showing empty storefronts

Observations from windshield survey: There are some homes that are very nicely maintained, but there are also several buildings that need attention/repair. There are vacant storefronts and pockets of the community with litter in the roads, fields, and houses that are not very well maintained.

051

http://www.cdc.gov/nccdphp/dnpao/index.html

38

Ozone and airborne particulate matter levels are two indicators used to determine an area’s Air Quality Index. In 2013, the US Environmental Protection Standard was lowered from 15 parts per meter, to 12ppm. This graph shows that in 2007 and 2008 Clay County’s air quality would have been worse than the 12ppm standard, but below the 15ppm standard. Since 2008, particulate matter in the air in Clay County has remained low.

Figure 6.2: Annual Particulate Matter (PM2.5) Levels

Source: US Environmental Protection Agency

Table 6.2 High Heat Index Days

Report Area

Total Weather Observations

Average Heat Index Value

Observations with High Heat Index Values

Observations with High Heat Index Values, Percentage

Clay County, IL

2,920 96.82 304 10.41%

Illinois 362,810 95.8 31,697 8.7%

United States 19,094,610 91.82 897,155 4.7%

Data Source: National Oceanic and Atmospheric Administration, North America Land Data Assimilation System (NLDAS) 1974-2011 Accessed via CDC WONDER.

Percentage of Weather Observations with High Heat Index Values:%


13.2

12.2

10.9

11.5

10.510.3

12.0

10

10.5

11

11.5

12

12.5

13

13.5

2007 2008 2009 2010 2011 2012

Mic

rogr

ams p

er M

eter

Annual Particulate Matter (PM2.5) Levels, 2007-2012

Clay

Environmental Climate and Air Quality

Photo of farm land

High heat index events are considered when temperature exceeds 103°F with humidity. The higher the heat index, the hotter the weather feels, since sweat does not readily evaporate and cool the skin. This is an important measure for estimating the risk to outside workers for heat exhaustion. Clay County has had 304 days of high heat index from 1974 to 2011. This is higher than State and National percentages. Since Clay County has a large agriculture industry, there are lots of outdoor workers at risk for heat exhaustion and heat stroke. 052

39

Unintentional injury death is a leading cause of death in the United States. In Clay County there are an estimated 58.9 deaths from unintentional injury per 100,000 population, compared to the Healthy People 2020 rate of 36 per 100,000.

Violent crime in Clay County is significantly lower than the State and National averages. From 2010-2012, there were only 8 reported violent crimes, making our rate per 100,000 population 56, compared to the state rate of 430 (Data Source: Uniform Crime Reporting Program). From 2010-2014, 45% of driving deaths in Clay County were alcohol-related, compared to the Illinois average of 36% alcohol-impaired driving deaths (Data Source: Fatality Analysis Reporting System).

Table 7.1 Accidental Death Rate

Report Area

Total Population




Clay County, IL 13,679 9 68.72 58.9

Illinois 12,867,528 4,361 33.89 32.7

United States 313,836,267 128,295 40.88 39.2

HP 2020 Target <= 36.0


Unintentional Injury (Accident) Mortality, Age-Adjusted Death Rate (Per 100,000 Pop.)


Table 7.2 Suicides 2010-2014

Clay County Number of Suicides, 2010-2014 2010 2011 2012 2013 2014 Number of Suicides 2 2 4 3 2 Source: IDPH Vital Statistics

In focus groups, the crime rate was brought up many times as a positive aspect of our community.

Environmental Injury


“I feel safe here”

“We look out for each other”

053



40

Sentinel indicators are for health conditions considered preventable or controllable with regular primary care. This indicator reports the discharge rate (per 1,000 Medicare enrollees) for conditions that are ambulatory care sensitive (ACS). ACS conditions include pneumonia, dehydration, asthma, diabetes, and other conditions which could have been prevented if adequate primary care resources were available and accessed by those patients. This indicator is relevant because analysis of ACS discharges allows demonstrating a possible “return on investment” from interventions that reduce admissions (for example, for uninsured or Medicaid patients) through better access to primary care resources.

Table 8.1 Preventable Hospital Events

Report Area

Total Medicare Part A Enrollees

Ambulatory Care Sensitive Condition Hospital Discharges

Ambulatory Care Sensitive Condition Discharge Rate

Clay County, IL

2,476 297 120.3

Illinois 1,420,984 92,604 65.2

United States 58,209,898 3,448,111 59.2

Data Source: Dartmouth College Institute for Health Policy Clinical Practice, Dartmouth Atlas of Health Care. 2012. Source geography: County Figure 8.1 Preventable Hospital Events Trend

Preventable Hospital Events, Age-Adjusted Discharge Rate (Per 1,000 Medicare Enrollees)


Sentinel Preventable Hospitalizations

054

41

Purpose: The primary purpose of the Local Public Health System Assessment is to promote improvement that will result in positive outcome for system performance. It is a way to better understand current system functioning and performance and prioritize strengths, weaknesses, and opportunities for improvement. The assessment is based on the 10 Essential Services of Public Health.

1. Monitor health status 2. Diagnose and investigate health problems 3. Inform, educate, and empower people 4. Mobilize community partnerships 5. Develop policies and plans 6. Enforce public health laws 7. Link people with needed personal health services 8. Assure competent health care workforce. 9. Evaluate effectiveness, accessibility, and quality 10. Research for new insights and innovative solutions

During meetings with local stakeholders, performance on each essential service was rated on a scale of “no activity” to “optimal activity” based on the table below.

Overview

Local Public Health System Assessment

055

42

Figure 2. Summary of Average Essential Public Health Service Performance Scores

The primary areas of strength for Clay County’s Local Public Health System include:

• Monitoring Health Status: The Health for Generations Coalition engages in the Illinois Plan for Local Assessment of Needs every five years. Significant effort has gone into getting broad, accurate, and informative data about the community.

• Mobilizing Partnerships: The Health for Generations Coalition meets regularly and encourages participation from a variety of sectors in the community health assessment and improvement process. The coalition tried to engage non-traditional public health partners.

• Link to Health Services: There are lots of services in our community, and agencies are knowledgeable and good at making referrals to one another. However, there is not a central resources manual that makes this information easily available to the public.

• Educate/Empower: There are many organizations in the community who partner with local schools, the legal community, health providers and public aid organizations. The education efforts are not always coordinated, but partners support each other’s programs and work together.

The main areas of weakness and opportunity for Clay County’s Local Public Health System include:

• Evaluate Services: Individual agencies have quality measures and customer satisfaction efforts, but there have not been formal efforts to evaluate progress on community health improvement. Community members have not been surveyed to assess if they are satisfied with community health improvement approaches.

• Enforce Laws: There are several County ordinances that have not been updated in a while. The local public health system works to prevent selling tobacco to minors and advocates for smoke free parks.

• Research Innovations: While partnerships with colleges and universities are abundant for developing the public health workforce, the local public health system participates only minimally in public health research.

(The full report is available at www.healthdept.org)

056

http://www.healthdept.org/

43

Forces are broad all-encompassing categories that include trends, events, and factors. The Health for Generations coalition brainstormed forces of change outside of our control that affect the local public health system and community.

Forces (Trends, Events, & Factors) Threats Posed Opportunities Created

Social Nutrition, increasing obesity

• Poor nutrition, physical inactivity, & lack of healthy restaurant choices. This can lead to increased rates of chronic diseases; such as heart disease and diabetes.

• Infrastructure development, increase wellness and/or exercise programs.

• KidFit – addressing childhood obesity. Evidence based. Improving brain activity

Poverty • Inability to feed children in summer months

• Changes in definition regarding eligibility for free and reduced lunch in the school system

• Transportation to services • Unaware of available

services

• Oil Belt Camp offers free lunch to anyone this summer

• Churches and Teen REACH/Beyond the Bell may offer Summer Food Program to help address childhood hunger.

Aging Population • Younger population leaving area

• Decrease in younger population means less demand for business and industry

• Small community willing to help each other and support local businesses

Substance Abuse • Lack of access to rehabilitation services

• Easy access to alcohol and other drugs

• Implement community education interventions

• COPE & Early intervention program.

Economic Unemployment (Closing of Southwire Factory)

• People lose their employer sponsored healthcare

• Relocating due to lack of job opportunities

• More need for public assistance programs

• Increase access to vocational and technical schools

• Increase career exploration in schools

Forces of Change Assessment

057

44

Lack of Funding for Programs

• Inability to meet health needs of the community

• Loss of social services • Increased unemployment

• Finding alternative funding sources outside of State funding.

High Insurance Deductibles

• Less likely to seek health care • Inability to access necessary

healthcare services

• Offer low deductibles at reasonable prices to employees

• Education on free preventative health care services offered through most health insurance plans

Political Repeal of Affordable Care Act without replacement

• Many people in Clay County could lose their health insurance coverage

• Stay informed • State and national advocacy.

Budget impasse • Program funding could potentially decrease and/or be cut

• Could lose important services to our community

• Delay in Medicaid reimbursement

• Find alternative funding sources outside state government

Environmental Tobacco Littering & Exposure to Secondhand Smoke

• Leads to high incidence of lung cancer

• Peer pressure among junior high and high school students

• Smoking cessation assistance • Smoke Free Parks • Education in schools at younger

age • More enforcement activities to

prevent access in adolescents Lack of awareness of community resources

• No updated central resource manual

• Opening conversation among community organizations

• All-encompassing document of community resources

Technological Unreliable internet and cell phone access

• Technology infrastructure in rural areas is still under developed.

• Lack of choice of internet providers

• More cell phone towers, more internet access.

Technology advantages quickly

• High expense for implementing new technologies

• Needed time to teach staff new technologies

• Learning new technology, especially Health IT

058

45

Scientific

Hospital Re-admissions

• Readmissions are considered preventable

• Increased financial burden on hospital

• Chronic Care Management Program – To reduce readmissions

059

46

Organizations and individuals represented and nature of contributions:

Organization Name Representing Medically

Underserve, low income, or minorities

Health 4 Generation

Coalition Member

CASPER Survey

development

Visioning Local Public Health System

Assessment

Forces of Change

Assessment

Clay County Counseling Service

Cara Rinehart

X X X X

Clay County Medical Reserve

Corp

Katelyn Brown

X

Clay County Health Department:

Environmental Health

Andrea Skewes

X X X X

Clay County Hospital

Carrie Miller X X X

Clay County Hospital

Brenda Conrad

X X X X X X

Clay County Health Department

Deena Mosbarger

X X X X X

City of Flora Randy Bukas X X Christopher Rural Health Planning

Corps.

Michelle McGee

X X X X

University of IL Extension

Carl Baker X X X X

Southwire/Sherwin Williams

Kari Warren X X

Flora School District Joel Hackney

X X X X X

Food Pantry and American Red Cross

Berenice Brown

X X X X

University of IL Extension: SNAP

Education

Michelle Fombelle

X X X X X

Country Financial and Coalition

Against Drug Abuse

Lisa Cash X

Golden Circle Nutrition Program,

Flora

Nancy Dehart

X X X

Clay County Farm Bureau

Sydney Lay X X X X

Heritage Woods Lucas Sigrist X X X X Clay County Health Department: Public

Health Nursing

Lyn Waller X X X X X

060

47

CEFS Public Transit Jennifer Moore

X X

Healthy Families Illinois

Doris Lusk X X X X X X

CCH Medical Clinic Ariane Souder

X X X x x

Southern Illinois Counseling Center

Louie Lusk X X X X

061

COMMUNITY HEALTH IMPROVEMENT PLAN

Clay County, IL

Prepared by the Clay County Health Department in April 2017

2017-2022

062

Table of Contents Introduction and Methods………………..……………………………………………………………………………………………………………..3 Tobacco and Substance Use-…………………………………………………………………………………………………………………………..4

o Community Health Plan Worksheet……………..………………………………………………………………………………………7 o Outcomes and Objectives…………………………………………………………………………………………………………………….8 o Participating Organizations and Community Resources……………………………………………………………………...11

Heart Disease and Obesity-……………………………………………………………………………………………………………………………12 o Community Health Plan Worksheet……………..……………………………………………………………………………………..15 o Outcomes and Objectives……………………………………………………………………………………………………………………16 o Participating Organizations and Community Resources……………………………………………………………………...19

Access to Care and Cancer-.……………………………………………………………………………………………………………………………20 o Community Health Plan Worksheet……………..……………………………………………………………………………………..23 o Outcomes and Objectives……………………………………………………………………………………………………………………24 o Participating Organizations and Community Resources……………………………………………………………………...26

063

Statement of Purpose: In March 2016, the Clay County Health Department completed the four MAPP assessments and led the Health for Generations Coalition through a process to identify the most important issues facing the community and write a plan on how to address these issues. The Health for Generation Coalition will use the Community Health Improvement Plan to direct efforts to improvement the health for all those who live, work, and play in Clay County.

Process: Each individual member of the Health for Generations Coalition was given the task of selecting the top 5 strategic issues. Responses were collected via Survey Monkey, a web-based survey tool. In March 2017, coalition members were emailed the link to the survey and the results of the 4 MAPP assessments. Coalition members were given two weeks to submit their responses.

The coalition responses were compiled and prioritized using the nominal group technique. The health issues were grouped into three strategic priorities. The results of the survey were shared with the Coalition at the end of March 2017.

Top 3 Strategic Issues:

o Tobacco and Substance Use o Heart Disease and Obesity o Access to Care and Cancer

Subcommittees were formed from each of the strategic priorities. Each subcommittee elected a group leader to facilitate and direct meetings. The subcommittees were responsible for developing a health improvement plan related to its respective strategic issues. Instructions on how to develop goals and interventions were emailed to each member. During the month of April the subcommittees convened to write their portion of the health improvement plan.

Introduction and Method

064

Goal: Reduce illnesses and deaths related to tobacco and substance use, including lung cancer, premature death, alcohol-impaired driving deaths, drug overdose deaths.

Rationale: The community CASPER survey and focus groups found that community members are very concerned about cancer. The type of cancer in Clay County with the highest incidence is lung cancer, with a rate of 79.5 per 100,000 population, compared to the state rate of 67.9 per 100,000 (Data source: State cancer profile 2009-2013). In 2015, approximately 16% of Clay County adults identified as current smokers compared to 15% in Illinois (Data source: County Health Rankings data). This is a leading cause of Clay County’s poor health outcomes in lung cancer and heart disease. More than half of Clay County residents have been smokers at some time in their life (63.4%) making them at risk for lung cancer and heart disease (Data source: BRFSS 2011). Surveys in Clay County schools found higher incidence of youth who smoke than in Illinois. Additionally, maternal smoking rates were higher in Clay County than in Illinois.

Illegal drug use was the 4th most commonly reported “important health issue” on the CASPER survey. Alcohol use was the 9th most important. The 2016 Illinois Youth Survey finds that by 12th grade, more than half of students (55%) had tried some type of substance including alcohol and drug (Data source: Illinois Youth Survey, 2016). 45% of driving deaths in Clay County were alcohol related, compared to 36% in Illinois (Data source: Fatality analysis data reporting system).

Supporting Data:

Former Tobacco Smokers Prevalence- Adults

Report Area

Survey Population (Adults Age 18 )

Total Adults Ever Smoking 100 or More Cigarettes


Clay County, IL 26,959 17,092 63.40%

Illinois 9,659,812 4,258,470 44.08%

United States 235,151,778 103,842,020 44.16%




The 2016 Illinois Youth Survey of 8th, 10th, and 12th graders in Clay County found that 13% of 8th graders had tried cigarettes, 15% of 10th graders and 35% of 12th graders. The most common sources of cigarettes for all

Lung Cancer Incidence





Illinois 1,370,544 9,306 67.9

United States 33,999,704 212,905 62.62

Data Source: State Cancer Profiles. 2009-13. Source geography: County* the age adjusted incidence rate (cases per 100,000 population per year)

Annual Lung Cancer Incidence Rate (Per 100,000 Pop.)


Strategic Issue #1: Tobacco & Substance Use

065

grades was from a friend of sibling. Other common sources included taking them from home without parents knowing and in 12th grade buying them from a gas station. Of 12th grade tobacco users, 25% reported that their parents gave them cigarettes. (Data Source: Illinois Youth Survey. Clay County 2016). The Clay County Health Department conducted a survey in 2016 in all junior high and high school classroom in Clay and Richland Counties. The survey found that approximately 20.6% of students in Clay and Richland Counties reported using cigarettes in the past 30 days, and 10.2% of those students reported being current frequent users (Data Source: Clay County Health Department Youth Tobacco Survey).

Maternal Smoking (2000-2008)

Source: I-QUERY, IDPH Vital Statistics The latest available data (2008) shows that maternal smoking rate is higher in Clay County than in Illinois, but is on a decreasing trend. More current data is not available. From 2010-2014, 45% of driving deaths in Clay County were alcohol-related, compared to the Illinois average of 36% alcohol-impaired driving deaths (Data Source: Fatality Analysis Reporting System).

422.8

534.1

395.4

350.2

451.4

508.6

370.1412.0

329.5

126.7121.2 113.9 110.9 116.4

97.5 98.7 97.089.8

0.0

100.0

200.0

300.0

400.0

500.0

600.0

2000 2001 2002 2003 2004 2005 2006 2007 2008

Age-

Adju

sted

Rat

e pe

r 100

,00

Mothers Who Smoke During Pregnancy, 2000-2008

Clay

Illinois

066

Clay County Youth Substance Use

Illinois Youth Survey, Clay County 2016

Relation to Health People 2020: The following Healthy People 2020 targets were referenced to set objectives.

o Reduce the percentage of adults currently smoking to 12.0%. o Increase the percentage of smokers who attempt to quit smoking within the past year to 80% o Reduce the percentage of adolescents 8 – 12 who have used cigarettes within the past 30 days to 16%. o Increase the percent of students who perceive great risk of harm associated with alcohol use to 44%.

067

Illness and death related to substance abuse and tobacco (including lung cancer, premature death, alcohol impaired driving deaths, and drug overdoses)

Risk Factor: Smoking and tobacco use

Risk Factor: binge drinking, drunk driving

Direct Contributing Factors: Peer pressure, family influences, community/attitude, health education

Direct Contributing Factors: youth access to alcohol, family history, and peer pressure, community attitude

Indirect Contributing Factors: lack of positive role models, lack of awareness of available resources, lack of supervision, media influences

Indirect Contributing Factors: lack of supervision at home, family acceptance, media influence, nothing else to do in area for fun, community acceptance of normal behavior

Risk Factor: Exposure to second-hand smoke

Direct Contributing Factors: family smoking in the home or car, public places or work places that allow smoking

Indirect Contributing Factors: lack of education on dangers, family history, stress, and community acceptance of normal behavior

Risk Factor: illegal drug use, prescription drug abuse

Direct Contributing Factors: physical and emotional abuse, youth access to drugs, community attitude

Indirect Contributing Factors: lack of coping skills, low self-esteem, access to mental health services, limited health education, community acceptance as normal behavior, lack of community resources

068

Outcome Objective #1: By 2022, reduce the percent of adults who smoke to 14%.

• Baseline (2015): Clay County 16%, Illinois Benchmark 15% currently identify as smokers, Healthy People 2020 Target 12%

o Data Source: County Health Rankings

Impact Objective 1.1: Increase the percent of smokers who attempt to quit smoking to 80% by 2019.

• Baseline (2011): Clay County 74.27%, Illinois Benchmark 61.21%, Healthy People 2020 Target 80% o Data Source: Behavioral Risk Factor Surveillance System (BRFSS), accessed through Community

Commons. Additionally, can monitor the number of calls to the Illinois Tobacco QuitLine from Clay County residents on a monthly and yearly basis.

o Interventions: Educate health care providers on the Illinois Tobacco QuitLine and brief intervention

method. (Baseline in 2017: 14 health care referral partners. Goal of increasing to at least 25)

Educate facilities that provide services to low-income populations on the Illinois Tobacco QuitLine.

Participate in factory health fairs and educate employees on the Illinois Tobacco QuitLine.

Explore partnerships with employers in Clay County to promote work-site based incentives and competitions to support individual cessation efforts.

Partner with WIC program at the Clay County Health Department to offer maternal smoking cessation tools to all mothers who smoke during pregnancy.

Develop partnerships with cancer prevention groups in Clay County to collaborate on efforts to reduce smoking and prevent lung cancer in the community.

• Evidence-Base: o Incentives and competitions to increase smoking cessation among workers:

https://www.thecommunityguide.org/findings/tobacco-use-and-secondhand-smoke-exposure-incentives-and-competitions-increase-smoking-1

o QuitLine interventions: https://www.thecommunityguide.org/findings/tobacco-use-and-secondhand-smoke-exposure-quitline-interventions

Impact Objective 1.2: Prevent the initiation of smoking among adolescents and teens. By 2020, reduce the percent of youth in grades 8 – 12 who have smoked cigarettes in the past 30 days to 16%.

• Baseline (2016): Clay & Richland County youth 20.6%, Healthy People 2020 Target 16% o Data Source: Clay County Health Department Social Norms Survey, and Illinois Youth Survey o Interventions:

Utilize the power of peer pressure to promote social norms through a marketing campaign against smoking in Clay County schools.

Work with Clay County schools to start smoking education younger, based on survey results that show when most youth first start smoking.

069




https://www.thecommunityguide.org/findings/tobacco-use-and-secondhand-smoke-exposure-quitline-interventions

https://www.thecommunityguide.org/findings/tobacco-use-and-secondhand-smoke-exposure-quitline-interventions

Through the Coalition against Drug Abuse (CADA), work with law enforcement to restrict sales of tobacco to minors.

• Evidence-Base: o Social Marketing: https://www.thecommunityguide.org/findings/tobacco-

use-and-secondhand-smoke-exposure-quitline-interventions o Community Mobilization to Restrict Sales to Minors:

https://www.thecommunityguide.org/findings/tobacco-use-and-secondhand-smoke-exposure-community-mobilization-additional-interventions

Outcome Objective #2: By 2022, reduce the proportion of nonsmokers exposed to second hand smoke, by increasing the number of smoke-free public places & places of employment to 100%.

• Baseline (2016): All of Flora public parks are smoke-free, not all of Louisville or Clay City yet. The Smoke Free Illinois Act requires all indoor public places and places of employment to be smoke-free.

o Data Source: Need to inventory number of public places and generate data to show percentage that are smoke-free. The Clay County Health Department tobacco coordinator tracks the number of Smoke Free Illinois Act violations and complaints. The Clay County Health Department tobacco coordinator tracks the number of establishments that have been inspected for compliance with the Smoke Free Illinois Act.

Impact Objective 2.1: Develop smoke-free policies at 100% of parks in Clay County by 2020.

• Baseline (2016): All of Flora public places are smoke-free, not all of Louisville or Clay City yet. o Data Source: Need to inventory number of public places and generate data to show percentage

that are smoke-free. o Interventions:

Inventory parks in Clay County and generate data to show the percentage that are smoke-free.

Collaborate with North Clay School and North Clay Park Board to establish a smoke-free policy in Louisville Park.

Promote smoke-free events, such as school sporting events, by collaborating with local community groups and schools.

• Evidence-Base: o Smoke-free policies for outdoor areas:

http://www.countyhealthrankings.org/policies/smoke-free-policies-outdoor-areas

Impact Objective 2.2: Ensure that all indoor public places & places of employment comply with the Smoke Free Illinois Act by 2019

• Baseline (2016): The Clay County Health Department conducted 55 smoke-free Illinois Act compliance checks, and received one complaint.

o Data Source: Clay County Health Department tobacco program coordinator. o Interventions:

070






Conduct at least 120 Smoke Free Illinois compliance checks per year. • Evidence-Base:

o Smoke-free policies: https://www.thecommunityguide.org/findings/tobacco-use-and-secondhand-smoke-exposure-smoke-free-policies

Outcome Objective #3: By 2022, decrease the percentage of Clay County youth reporting alcohol use in the past year by 10% to 32% of 8th graders, 34% of 10th graders, and 44% of 12th graders.

• Baseline (2016): Clay County: 36% of 8th grade students, 38% of 10th grade students, and 49% of 12th grade students report alcohol use in the past year.

o Data Source: Illinois Youth Survey

Impact Objective 3.1: By 2020, increase the percent of 8th and 10th grade parents/guardians in Clay County who have talked to their students about not using alcohol in the past year to 52% in 8th grade and 58% in 10th grade.

• Baseline (2016): 48% of 8th grade and 53% of 10th grade students in Clay County report in the last year parents/guardians talked to the about not using alcohol.

o Data Source: Illinois Youth Survey o Interventions:

Send prevention post cards to all parents of 8th and 10th grade students three times per year encouraging them to talk to their children about alcohol.

Develop and promote three radio ads during high traffic time slots about talking to your children about alcohol.

• Evidence-Base: o Using mass media against underage drinking:

http://www.countyhealthrankings.org/policies/mass-media-campaigns-against-underage-binge-drinking

Impact Objective 3.2: By 2020, increase the percent of Clay County 8th grade students who perceive great risk of harm associated with alcohol use to 44%.

• Baseline (2016): 38% of 8th grade students perceive great risk of harm associated with having five or more alcoholic drinks on a single occasion once or twice a week. Healthy People 2020 target of 44%.

o Data Source: Illinois Youth Survey o Interventions:

Publish stall talk messages three times per year to display in all school bathroom stalls capturing the majority of target audience and emphasizing message of the danger of binge drinking.

Display posters in school high traffic areas and entrances on the dangers of binge drinking.

• Evidence-Base:

071

https://www.thecommunityguide.org/findings/tobacco-use-and-secondhand-smoke-exposure-smoke-free-policies

https://www.thecommunityguide.org/findings/tobacco-use-and-secondhand-smoke-exposure-smoke-free-policies



o Media campaigns against binge drinking: http://www.countyhealthrankings.org/policies/mass-media-campaigns-against-underage-binge-drinking

Other goals related to this strategic issue: (These goals either do not currently have adequate data sources, funding or partnerships to fully develop the objective, but are areas to further explore in the next five years)

o Create a mentorship program to connect at risk youth to positive role models o Measure the impact of drug use in Clay County:

o Work with the Coroner to quantify the number/rate of drug overdose deaths in Clay County o Work with Sherriff to monitor the number of drug related crimes in Clay County o Conduct community survey to quantify prescription drug and illicit drug abuse concerns

o Increase admissions to substance abuse treatment programs o Reduce access to prescription drugs by holding drug take back events, and educating

parents/guardians/grandparents on restricting access to minors. o Develop performance measures and evaluate drug court program in Clay County

Community Resources Available for this Priority:

o Clay County Health Department o Illinois Tobacco Quit Line o Clay County Hospital Behavioral Health and COPE program o Coalition against Drug Abuse o Southeastern Illinois Counseling o Clay County Cancer Crusaders o Clay County Schools o Clay County Sherriff o Clay County Probation Assistant o City of Flora Police Department

Estimated funding:

Enhance current programs using existing funding

Potential New Funding Sources/In-Kind Support

Explore new grants from federal or state sources to support Coalition against Drug Abuse (CADA) initiatives

072



Goal: Improve heart health and quality of life through promotion of healthful diets and active lifestyles to ultimately prevent heart attacks, strokes and premature death.

Rationale: The percentage of adults with heart disease in Clay County (11.3%) is significantly higher than the state (3.8%) and national averages (4.4%). Diseases of the heart is the leading cause of death in Clay County (IDPH Vital Statistics). The CASPER household survey found that more than half of households (59.2%) had at least one member with hypertension or heart disease. Additionally, heart disease was the third most commonly identified health concern by the community during the CASPER survey. Clay County’s obesity rate has increased to 32% since 2004. Obesity was the second most commonly reported important health issues from Clay County citizens through the CASPER survey. The percentage of adults in Clay County who report no leisure time physical activity has grown over the last ten years to 33%. The CASPER survey showed that residents of the average Clay County household exercised 3 days in a week. 35% of Clay County households had residents that exercised every day! But, in 25% of Clay County households, no one exercised in the last 7 days.

Supporting Data:

Table 4.9 Heart Disease Prevalence


Total Adults with Heart Disease


Clay County, IL 26,959 3,048 11.3%

Illinois 9,681,141 369,926 3.8%

United States 236,406,904 10,407,185 4.4%




Table 4.9 Stroke Mortality Rate





Clay County, IL 13,679 10 76.03 50.3

Illinois 12,867,528 5,368 41.72 37.9

United States 313,836,267 129,754 41.34 37.3

HP 2020 Target

<= 33.8


Stroke Mortality, Age-Adjusted Death Rate (Per 100,000 Pop.)


Strategic Issue #2: Heart Disease & Obesity

073



Data Source: County Health Rankings; National Diabetes Surveillance System; Diabetes Interactive Atlas

Physical Inactivity

Data Source: County Health Rankings; CDC National Diabetes Surveillance System, Behavioral Risk Factor Surveillance System

074



o Increase the proportion of adults at a healthy weight to 33.9%. o Reduce the proportion of adults who get no leisure time physical activity to 32.6%. o Reduce stroke mortality to 37.3 per 100,000.

0%

5%

10%

15%

20%

25%

30%

35%

40%


How many days during the last 7 did a member of your household perform at least 30 min of physical activity (other

than during your regular job)?

075

Heart Disease, Heart Attack mortality, Stroke mortality and premature death

Risk Factor: Overweight or Obese

Direct Contributing Factors: Lack of physical activity

Direct Contributing Factors: Have not had blood work done or blood pressure checked, not following doctor recommendations for diet and exercise

Indirect Contributing Factors: lack of motivation, desk jobs, too much TV and screen time, gym hours or fees, lack of sidewalks and walk-able/bike-able streets

Indirect Contributing Factors: do not see primary care physician regularly, unaware of resources in community, financial stress, transportation

Direct Contributing Factors: Unhealthy diet

Indirect Contributing Factors: abundance of unhealthy options, lack of education or understanding of what foods are unhealthy, not enough healthy options, poverty

Risk Factor: Unaware of risk factors such as high cholesterol & high blood pressure

076

Outcome Objective #1: By 2022, reduce the percent of adults with heart disease to 10%.

• Baseline (2011): Clay County 11.3%, Illinois Benchmark 3.0% currently has heart disease. No healthy people 2020 goal.

o Data Source: Behavioral Risk Factor Surveillance System (BRFSS), accessed through Community Commons.

Impact Objective 1.1: By 2022, increase the proportion of adults who are at a healthy weight to 33.9%.

• Baseline (2011): Clay County 29.5% (70.5% are obese or overweight), Healthy People 2020 target to achieve 33.9% at healthy weight.

o Data Source: Behavioral Risk Factor Surveillance System (BRFSS) o Interventions:

Launch a “Health for Generations” Facebook page and website. Utilize social media to share messaging campaigns about choosing healthy options (i.e. Rethink your drink, Swap it to Drop it).

Create a cookbook with heart healthy recipes and distribute throughout the community. Promote breastfeeding through peer counselor program and community breastfeeding

support initiatives. Collaborate with schools, churches, and community groups to offer healthy options at

community events (like school sporting event concession stands). Provide healthy ideas for snacks, such as water instead of soda, fresh fruit and vegetables, popcorn (without butter and salt), and promote healthy options at events using social media.

Explore restaurant health improvement initiatives. Work with restaurant owners to develop menu items that are low calorie, heart healthy, and contain fruits and vegetables. Promote healthy menu options using social media, and point of decision prompts in restaurant menus or signage on tables.

Promote local farmers market as a way to increase fruit and vegetable consumption. Highlight success stories of local citizens who have lost weight and developed a

healthier life style using social media. Launch a community based weight loss challenge competition with local employers.

• Evidence-Base: o Breastfeeding promotion program:

http://www.countyhealthrankings.org/policies/breastfeeding-promotion-programs

o Community weight loss challenge: http://www.countyhealthrankings.org/policies/community-weight-loss-challenges

o Point of Purchase Marketing for healthy foods: http://www.countyhealthrankings.org/policies/point-purchase-prompts-healthy-foods

o SWAP it to DROP it campaign, restaurant program, marketing health, farmers market promotion : http://heartsbeatback.org/about-us/fact-sheets

Impact Objective 1.2: By 2020, reduce the proportion of adults who have no leisure time physical activity to 29%

077



http://www.countyhealthrankings.org/policies/community-weight-loss-challenges

http://www.countyhealthrankings.org/policies/community-weight-loss-challenges

http://www.countyhealthrankings.org/policies/point-purchase-prompts-healthy-foods

http://www.countyhealthrankings.org/policies/point-purchase-prompts-healthy-foods

• Baseline (2011): Clay County 33% report no leisure time physical activity, Illinois benchmark 25%, Healthy People 2020 target 32.6%.

o Data Source: Behavioral Risk Factor Surveillance System (BRFSS), accessed through County Health Rankings

o Interventions: Launch a “Health for Generations” Facebook page and website. Utilize social media to

promote physical activity opportunities in Clay County. Offer free community exercise classes to try different types of exercise available in the

community (yoga, Cross fit, Zumba, etc.) Promote free senior aerobics exercise classes. Start a community based support system to encourage walking and biking by scheduling

regular times and locations for a group to meet to walk or bike together. Invite gym owners and school gym teachers to participate in the coalition and design

physical activity challenges among members/students. Distribute point of decision prompts around the community and to worksite to

encourage people to be active (i.e. take the stairs) • Evidence-Base:

o Physical activity programs for older adults: http://www.countyhealthrankings.org/policies/activity-programs-older-adults

o Community fitness programs: http://www.countyhealthrankings.org/policies/community-fitness-programs

o Community-based social support for physical activity: http://www.countyhealthrankings.org/policies/community-based-social-support-physical-activity

o Community-wide physical activity campaigns: http://www.countyhealthrankings.org/policies/community-wide-physical-activity-campaigns

o Point of decision prompts for physical activity: http://www.countyhealthrankings.org/policies/point-decision-prompts-physical-activity

Outcome Objective #2: By 2022, reduce stroke mortality to 45.2 per 100,000.

• Baseline (2014): Clay County 50.3 per 100,000, Illinois Benchmark 37.9 per 100,000. Healthy People 2020 goal of 37.3 per 100,000.

o Data Source: CDC National Vital Statistics System, accessed via Community Commons.

Impact Objective 2.1: By 2019, increase the number of people who get annual blood work done by 10%.

• Baseline: Clay County Hospital and Health Department estimate number of blood work vouchers sold at community events, and number of blood tests done on an annual basis.

o Data Source: Clay County Health Department and Clay County Hospital o Interventions:

078

http://www.countyhealthrankings.org/policies/activity-programs-older-adults

http://www.countyhealthrankings.org/policies/activity-programs-older-adults

http://www.countyhealthrankings.org/policies/community-fitness-programs

http://www.countyhealthrankings.org/policies/community-fitness-programs

http://www.countyhealthrankings.org/policies/community-based-social-support-physical-activity

http://www.countyhealthrankings.org/policies/community-based-social-support-physical-activity

http://www.countyhealthrankings.org/policies/community-wide-physical-activity-campaigns

http://www.countyhealthrankings.org/policies/community-wide-physical-activity-campaigns

http://www.countyhealthrankings.org/policies/point-decision-prompts-physical-activity

http://www.countyhealthrankings.org/policies/point-decision-prompts-physical-activity

Offer low cost blood work, cholesterol checks and free blood pressure checks at community events.

• Evidence base: o Reduce out-of pocket costs of cardiovascular disease preventative services:

https://www.thecommunityguide.org/findings/cardiovascular-disease-reducing-out-pocket-costs-cardiovascular-disease-preventive-services

Impact Objective 2.1: By 2020, increase the number of people who are aware of the early warning symptoms and signs of a stroke and the importance of accessing rapid emergency care by calling 9-1-1 by 10%.

• Baseline: Needs to be generated by estimating the number of children educated through school programs, and adults through trainings, events, and media reach.

o Data Source: Health for Generations subcommittee will track the number of people reached through school education programs, trainings, events and media.

o Interventions: Launch community based campaign through Health for Generations coalition to issue

shared messaged on early warning signs of a stroke. Participate in community events to educate the public on the early warning signs of

strokes. • Evidence base:

o Recognizing signs and symptoms of a Stroke: https://www.cdc.gov/dhdsp/docs/ss_coverdell_arkansas.pdf


o Offer grocery store tours with a dietitian to identify healthy and budget-friendly options that can be purchased locally.

o Support local employers to offer work site wellness programs by providing work site wellness checklists. The Health for Generations coalition could host a worksite wellness symposium for local HR representatives to offer ideas and strategies to improve worksite wellness programs.

o Create a community garden or offer trainings through University of Illinois Extension Master Gardeners to promote growing your own fruit and vegetables.

o Develop more walk-able/bike-able communities through Complete Streets program.


o University of Illinois Extension o Chamber of Commerce o Clay County Health Department o Local gyms

079



https://www.cdc.gov/dhdsp/docs/ss_coverdell_arkansas.pdf

o Clay County Hospital o Local worksite HR and work site wellness coordinators o City of Flora o Clay County Farm Bureau o Clay County Master Gardeners o Clay County School Districts o American Red Cross o Clay County Food Pantry o Golden Circle Nutrition Program

Estimated funding:

Enhance current programs using existing funding.


Explore new grants from federal or state sources to support Health for Generations Coalition initiatives

080

Goal: Improve access to quality care and improve utilization of preventative services.

Rationale: The entirety of Clay County is designated as a “Health Professional Shortage Area” (HPSA), defined as having a shortage of primary medical care, dental, or mental health professionals. The access to primary care physicians is especially low. Clay County lost the only Medicaid dental provider in the County this year. During focus groups, access to health care came up in many forms and in all age groups. It was the #1 most common theme of all focus groups. In the CASPER survey, access to health care was one of the top 10 health issues important to Clay County residents. Households reported examples of issues such as: mental health service availability, specialized physicians, and cancer care out of the area. Cancer was the #1 most commonly reported important health issue to residents in Clay County from the CASPER survey. In fact, it was reported twice as many times as any other health issue. During focus groups, several people mentioned that they were concerned about Clay County’s cancer rate. There is a wide-spread perception in the community that cancer rates in Clay County are especially high. This is being included in the ‘Access to Health Care’ priority, to create objectives focused on encouraging the population to utilize cancer screening options available in Clay County. Clay County’s percentage of female Medicare enrollees age 67-69 that had at least one mammogram over a two-year period is decreasing below the State and National averages. Clay County’s cancer mortality rate is slightly higher than the Illinois and National Rate, all of which are higher than the Healthy People 2020 Target (160.6).

Supporting Data:

Primary Medical Care Provider in Clay County

Frequency (n=169) Projected households Projected % 95% CI Who does your household use for primary and ongoing medical care?

Doctor's Clinic 145 5325 86.0% 78.6 - 93.4 Hospital ER 11 399 6.4% 1.2 - 11.7

Military 5 165 2.7% 0.4 - 5.0 Other 4 139 2.3% 0 - 4.5

Urgent Care/ Walk-in 3 91 1.5% 0 - 3.2 Don't Know 1 71 1.2% 0- 3.5


Strategic Issue #3: Access to Care & Cancer

081


Mammography Trend


082

Cancer Mortality Rate





Clay County, IL 13,679 33 244.18 174.5

Illinois 12,867,528 24,326 189.05 173.9

United States 313,836,267 581,919 185.42 166.3

HP 2020 Target

<= 160.6


Cancer Mortality, Age-Adjusted Death Rate (Per 100,000 Pop.)



o Increase the proportion of persons who have a specific source of ongoing care to 95% o Decrease the proportion of persons who are unable to or delay ongoing medical care to 9%. o Increase the percent of women who get breast cancer screenings to 81.1%

083



Access to Care & Cancer

Risk Factor: Delay in seeking medical care

Risk Factor: Not using preventative services like cancer screenings & dental cleanings

Direct Contributing Factors: Cost/ lack of or insufficient coverage

Direct Contributing Factors: lack of knowledge of recommended and available preventative services, physicians have high patient volume and limited time to discuss screenings, no Medicaid dental provider

Indirect Contributing Factors: lack of insurance, unemployment, economic conditions, lack of full time work opportunities with benefits

Indirect Contributing Factors: lack of education, medical provider shortage, poor communication and collaboration between local community organizations

Direct Contributing Factors: Unable to get an appointment

Indirect Contributing Factors: no urgent care in Flora, inconvenient provider hours, high patient volume per physician, distance, transportation issus

084

Outcome Objective #1: Increase the proportion of persons who have a specific source of ongoing care to 95% by 2022.

• Baseline (2016): Clay County 88.7% of households utilize doctor clinic of military for ongoing medical care, the other 11.3% use the ER, walk-in clinic, or don’t have a doctor. The Healthy People 2020 goal is to increase the proportion of persons who have a specific source of ongoing care to 95%.

o Data Source: Clay County Health Department CASPER Survey

Impact Objective 1.1: Reduce the proportion of persons who are unable to or delay obtaining medical care to 16% by 2020.

• Baseline (2016): Clay County 18% report a barrier to seeking medical care, including unable to get appointment, inconvenient hours, cost, and distance. The Healthy People 2020 goal is the decrease the proportion of persons who are unable to or delay ongoing medical care to 9%.

o Data Source: Clay County Health Department CASPER Survey o Interventions:

Expand provider office hours and offer more walk-in clinic opportunities Offer educational sessions to help people sign up for health insurance Partner with CEFS transportation and FQHC to reduce barriers to medical care due to

distance and transportation. Distribute education through local industries on preventative services covered through

insurance plans. • Evidence base:

o Health insurance enrollment support: http://www.countyhealthrankings.org/policies/health-insurance-enrollment-outreach-support

o Health literacy interventions: http://www.countyhealthrankings.org/policies/health-literacy-interventions

Outcome Objective #2: By 2022, increase the proportion of women who received breast cancer screenings to 81.1%

• Baseline (2011): 73% of women in Clay County had a mammogram in last year. The Healthy People 2020 target is to increase to 81.1%

o Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Impact Objective 2.1: Increase the percent of female Medicare enrollee’s aged 67-69 that receive mammography screenings to 60.5% by 2020.

• Baseline (2014): Clay County 55% o Data Source: Dartmouth Atlas of Health Care, accessed via County Health Rankings o Interventions:

Education through women’s wellness events and messaging through Health for Generations Coalition social media

Education to local providers on cancer screening utilization data

085

http://www.countyhealthrankings.org/policies/health-insurance-enrollment-outreach-support

http://www.countyhealthrankings.org/policies/health-insurance-enrollment-outreach-support

http://www.countyhealthrankings.org/policies/health-literacy-interventions

http://www.countyhealthrankings.org/policies/health-literacy-interventions

Outcome Objective #3: By 2022, recruit 2 additional primary care physicians, and 1 additional dental provider.

• Baseline (2014): Clay County had 14.79 primary care physicians per 100,000 population and 67 dentists per 100,000 population.

o Data Source: US Health and Human Services, Health Resources and Services Administration, Area Health Resource File, accessed via County Health Rankings.

Impact Objective 2.1: By 2022, recruit a dental provider to meet the needs of Medicaid population.

• Baseline (2017): Clay County 0 Medicaid dental providers. o Data Source: Health for Generations Coalition o Interventions:

Work as a coalition to identify methods to recruit dental providers or otherwise meet the dental needs of Medicaid population.

Impact Objective 2.1: By 2022, increase the percent of the population aged 25+ with a bachelor’s degree or higher to 15%.

• Baseline (2014): 13.4% of Clay County’s population age 25+ had a bachelor’s degree or higher, compared to 31.9% in Illinois.

o Data Source: U.S. Census Bureau o Interventions:

Recruit Clay County residents who are currently in Medical School or in medical careers to return and serve in Clay County.

Support health care career mentoring opportunities, and support the health occupations class.

Offer internship opportunities in public health or other health care field to help Clay County residents currently seeking bachelor’s degrees.

Participate in career fairs to encourage high school students to enter medical careers.


o Offer classes, training, or support groups for caregivers and residents with Alzheimer’s and Dementia. o Create a central resource manual that can be used to increase collaboration and communication about

available resources in the community.

086


o Clay County Health Department o Clay County Hospital o Christopher Rural Health Planning Corps. o Clay County Food Pantry o Heritage Woods o CEFS Public Transit o Clay Home Health and Hospice o Clay County Farm Bureau

Estimated funding:

Enhance current programs using existing funding


Explore new grants from federal or state sources to support Health for Generations Coalition initiatives.

087